3 - (SYM 18) Improving Access to Transdiagnostic Group Cognitive Behavioural Therapy for Emotional Disorders in Spanish Primary Care. the Psicap Randomized Controlled Trial

Introduction: Emotional disorders such as depression, anxiety, and somatoform conditions are highly prevalent in Spanish primary care and represent a major public health challenge due to their clinical and economic impact. Cognitive Behavioural Therapy (CBT) is an effective intervention, and expanding its delivery in primary care could yield substantial public health benefits. In Spain, the PsicAP randomized controlled trial demonstrated the effectiveness of a transdiagnostic CBT (TD-CBT) protocol. In addition, an ongoing study (PsicAP-CV) conducted in two primary care centres in the Valencian Community further examines its impact. Drawing on data from both studies, this presentation analyses key mechanisms of change, including emotion regulation strategies, therapist experience, and the influence of psychotropic medication on TD-CBT outcomes.

Method: The PsicAP trial was conducted in 22 Spanish primary care centres, comparing TD-CBT plus treatment as usual (TAU) over 12–14 weeks with TAU alone. The study included 1,061 participants and assessed clinical outcomes as well as post-treatment annual income. The PsicAP-CV study uses a Stepped Wedge design with 130 patients assigned either to immediate TD-CBT or to a waiting group that later received the intervention, focusing on moderators and mediators of treatment effects.

Results: Participants receiving TD-CBT+TAU showed greater symptom improvement than those receiving TAU alone, with medium effect sizes and recovery rates close to 50%, comparable to NHS TTad services in England. These gains were maintained at 3-, 6-, and 12-month follow-ups. This treatment was found cost-effective and cost-beneficial, as the proportion of participants earning more than €24,000 annually increased in the TD-CBT+TAU group only. In the PsicAP-CV study, therapist experience did not significantly affect outcomes, emotion regulation emerged as a key mediator, and antidepressant use moderated results by reducing TD-CBT effectiveness.

Discussion: TD-CBT implemented in Spanish primary care produces outcomes comparable to NHS TTad programs. Understanding mechanisms of change may enhance CBT implementation and improve access to effective psychological treatments in primary care.